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  <title mediaType="text/plain" representation="TXT">HRAPPP FOR MISS J. RUBIN LISA</title>
  <effectiveTime value="20151127200244.861+0700" />
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      <id root="2.16.840.1.113883.4.1" extension="123-456-7890" />
      <addr use="HP">
        <streetAddressLine partType="SAL">718 Spadafore Drive Leeper, PA 16233</streetAddressLine>
        <city partType="CTY">CARROLLTON</city>
        <state partType="STA">TX</state>
        <postalCode partType="ZIP">75007-4808</postalCode>
        <country partType="CNT">US</country>
      </addr>
      <telecom value="814-744-8787" use="HP" />
      <patient xsi:type="POCD_MT000040.Patient" classCode="PSN" determinerCode="INSTANCE">
        <name>
          <given partType="GIV">J. Rubin</given>
          <family partType="FAM">Lisa</family>
        </name>
        <administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGender" displayName="F" />
        <birthTime value="19660305000000.000+0700" />
        <maritalStatusCode code="M" codeSystem="2.16.840.1.113883.5.2" codeSystemName="MaritalStatus" displayName="Married" />
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  <author typeCode="AUT" contextControlCode="OP">
    <time value="20151127200244.861+0700" />
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      <code code="207QA0505X" codeSystem="2.16.840.1.113883.6.101" codeSystemName="MAD" displayName="Adult Medicine" />
      <assignedPerson classCode="PSN" determinerCode="INSTANCE">
        <name>
          <given partType="GIV">MAD</given>
          <family partType="FAM">MAD</family>
          <suffix partType="SFX">MAD</suffix>
        </name>
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  </author>
  <custodian typeCode="CST">
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        <name>MAD</name>
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          <code code="10157-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Family History" />
          <title mediaType="text/plain" representation="TXT">FAMILY HISTORY</title>
          <text mediaType="text/x-hl7-text+xml" language="en-US">
<table width="100%" border="1">
    <thead>
        <tr>
            <th>Diagnosis</th>
        </tr>
    </thead>
    <tbody>
    <tr>
      <td>Abdominal Aortic Aneurysm</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Alzheimer's disease or dementia</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Arthritis</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Asthma</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Blood clots</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Breast cancer</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Colorectal cancer</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Yes</td>    </tr>
    <tr>
      <td>Coronary heart disease</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Yes</td>    </tr>
    <tr>
      <td>Depression</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Diabetes</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Glaucoma</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>High blood pressure</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>High cholesterol</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    </tbody>
</table>
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          <title mediaType="text/plain" representation="TXT">FUNCTIONAL STATUS</title>
          <text mediaType="text/x-hl7-text+xml" language="en-US">
<table width="100%" border="1">
    <thead>
        <tr>
            <th>Functional Condition</th>
            <th>Effective Dates</th>
            <th>Condition Status</th>
            </tr>
    </thead>
    <tbody>
    <tr>
      <td>Are you a current smoker?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>How many alcoholic drinks do you have in a typical week?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>0</td>    </tr>
    <tr>
      <td>Do you engage in risky sexual behavior, have multiple sex partners, or engage in IV drug use?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>How many days a week do you average 30 minutes of physical activity, such as walking?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>5 or more</td>    </tr>
    <tr>
      <td>In a typical day, how many servings of foods high in saturated or trans fat do you consume (cookies, cakes, fried food)?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>0-1</td>    </tr>
    <tr>
      <td>What is your current living arrangement?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Live with one or more people</td>    </tr>
    <tr>
      <td>Do you feel safe in your home (good lighting, handrails on stairs, no-slip bath)?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Yes</td>    </tr>
    <tr>
      <td>Can you perform basic housework (cooking, cleaning, shopping) on your own?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Yes</td>    </tr>
    <tr>
      <td>Can you take personal care of yourself, including bathing and dressing?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Yes</td>    </tr>
    <tr>
      <td>Can you  manage your own proper medication use?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Yes</td>    </tr>
    <tr>
      <td>Do you feel in control of your finances?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Yes</td>    </tr>
    <tr>
      <td>What is your primary mode of transportation?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Drive myself</td>    </tr>
    </tbody>
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          <code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of immunizations" />
          <title mediaType="text/plain" representation="TXT">IMMUNIZATIONS</title>
          <text mediaType="text/x-hl7-text+xml" language="en-US">
<table width="100%" border="1">
    <thead>
        <tr>
            <th>Vaccine</th>
            <th>Date</th>
            <th>Status</th>
        </tr>
    </thead>
    <tbody>
    <tr>
      <td>Influenza vaccination (flu shot)?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Within last 12 months</td>    </tr>
    <tr>
      <td>Annual influenza recommendation</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Current- repeat annually. NEXT DUE: FALL 2015</td>    </tr>
    <tr>
      <td>Pneumococcal vaccination (for pneumonia) vaccination?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Within last 12 months</td>    </tr>
    <tr>
      <td>Pneumococcal vaccine recommendation</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Current- Recommended for all adults >65 (the Advisory committee on Immunization Practices (ACIP) recommends that all adults 65 years and older receive a dose of PCV13 followed by a dose of PPSV23 6 to</td>    </tr>
    <tr>
      <td>Hepatitis B vaccination series</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Hepatitis B recommendation</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Low risk- not recommended at this time. NEXT DUE: N/A</td>    </tr>
    <tr>
      <td>Bone density screening</td>      <td>29/8/2015 11:59:26 AM</td>      <td>1-5 years ago</td>    </tr>
    <tr>
      <td>Bone density recommendation</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Current- repeat every 10-15 years. NEXT DUE 2023 OR AS RECOMMENDED BY YOUR DOCTOR.</td>    </tr>
    <tr>
      <td>Cholesterol blood test (lipid panel)</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Within last 12 months</td>    </tr>
    <tr>
      <td>Cholesterol blood test recommendation</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Current- repeat every 3-12 months due to history of high cholesterol.  NEXT DUE: 9/2015</td>    </tr>
    <tr>
      <td>Diabetes screening test (blood sugar)</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Within last 12 months</td>    </tr>
    <tr>
      <td>Diabetes screening recommendation</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Current- repeat every 3-6 months (Hgb A1C) due to history of diabetes. 09/2015</td>    </tr>
    <tr>
      <td>Colorectal cancer screening</td>      <td>29/8/2015 11:59:26 AM</td>      <td>1-5 years ago</td>    </tr>
    <tr>
      <td>Colorectal cancer screening recommendation</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Current- repeat every 5 years (sooner if recommended by gastroenterologist) due to history of polyps  AND/OR family history of colon cancer until age 75-85. NEXT DUE: 1/2016 or as recommended by your</td>    </tr>
    <tr>
      <td>Glaucoma screening</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Within last 12 months</td>    </tr>
    <tr>
      <td>Glaucoma screening recommendation</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Current- repeat every 6-12 months due to history of diabetes, family history of glaucoma, AND/OR other genetic risk factors. NEXT DUE 10/2015</td>    </tr>
    <tr>
      <td>HIV Screening</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>HIV screening recommendation</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Low risk- not recommended at this time. NEXT DUE; N/A</td>    </tr>
    <tr>
      <td>MEN ONLY: Prostate cancer screening</td>      <td>29/8/2015 11:59:26 AM</td>      <td>N/A</td>    </tr>
    <tr>
      <td>Prostate cancer recommendation</td>      <td>29/8/2015 11:59:26 AM</td>      <td>n/a</td>    </tr>
    <tr>
      <td>WOMEN ONLY: Mammogram</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Within last 12 months</td>    </tr>
    <tr>
      <td>Mammogram recommendation</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Current- repeat as recommended by specialist due to history of breast pathology/abnormality. NEXT DUE: 1/2016</td>    </tr>
    <tr>
      <td>WOMEN ONLY: Pap and pelvic exam</td>      <td>29/8/2015 11:59:26 AM</td>      <td>1-5 years ago</td>    </tr>
    <tr>
      <td>Pap and pelvic exam recommendation</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Current- routine testing not recommended over age 65 who have had adequate prior screenings and are not at high risk. NEXT DUE:  AS NEEDED</td>    </tr>
    </tbody>
</table>
</text>
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          <code code="10160-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="HISTORY OF MEDICATION USE" />
          <title mediaType="text/plain" representation="TXT">Medications</title>
          <text mediaType="text/x-hl7-text+xml" language="en-US">
<table width="100%" border="1">
    <thead>
        <tr>
            <th>Medication</th>
            <th>Instructions</th>
            <th>Start Date</th>
            <th>Status</th>
        </tr>
    </thead>
    <tbody>
    <tr>
      <td>METFORMIN HYDROCHLORIDE</td>      <td>twice daily</td>      <td></td>      <td>diabetes</td>    </tr>
    <tr>
      <td>glimeperide</td>      <td>twice daily</td>      <td></td>      <td>diabetes</td>    </tr>
    <tr>
      <td>LISINOPRIL</td>      <td>daily</td>      <td></td>      <td>hypertension</td>    </tr>
    <tr>
      <td>vitamin d</td>      <td>daily</td>      <td></td>      <td>supplement</td>    </tr>
    <tr>
      <td>multivitamin</td>      <td>daily</td>      <td></td>      <td>supplement</td>    </tr>
    <tr>
      <td>pradaxa</td>      <td>daily</td>      <td></td>      <td>prophylaxis for post hip surgery</td>    </tr>
    </tbody>
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        <section classCode="DOCSECT" moodCode="EVN">
          <templateId root="2.16.840.1.113883.10.20.22.2.5.1" />
          <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problems" />
          <title mediaType="text/plain" representation="TXT">Problems</title>
          <text mediaType="text/x-hl7-text+xml" language="en-US">
<table width="100%" border="1">
    <thead>
        <tr>
            <th>Condition</th>
            <th>Effective Dates</th>
            <th>Condition Status</th>
        </tr>
    </thead>
    <tbody>
    <tr>
      <td>Alzheimer's disease or dementia</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Arthritis</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Asthma</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Atrial fibrillation (irregular heart beat)</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Cancer</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Yes</td>    </tr>
    <tr>
      <td>Congestive Heart Failure (CHF)</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>COPD or emphysema</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Coronary heart disease (angina, heart attack, angioplasty or bypass surgery)</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Diabetes</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Yes</td>    </tr>
    <tr>
      <td>Depression or mental illness</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Food allergies (e.g., gluten, dairy, nuts, fish)</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>High blood pressure</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Yes</td>    </tr>
    <tr>
      <td>High cholesterol</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Yes</td>    </tr>
    <tr>
      <td>Irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD)</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Kidney Disease or Kidney Failure</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Seasonal allergies</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Sleep Apnea</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Stroke or TIA</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Feeling dizzy or imbalanced</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Blurry vision or trouble seeing</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Sexual problems</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Trouble eating well</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Teeth, gum or denture problems</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Being extremely tired</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Feeling extremely stressed</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Feeling extremely angry</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Chronic pain</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Out of breath or trouble breathing</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Chest pains or fast heartbeat</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Sleeping problems</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Migraines or severe headaches</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>How would you rate your overall health?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Excellent</td>    </tr>
    </tbody>
</table>
</text>
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          <code code="29762-2" codeSystem="2.16.840.1.113883.6.1" displayName="SOCIAL HISTORY" />
          <title mediaType="text/plain" representation="TXT">SOCIAL HISTORY</title>
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<table width="100%" border="1">
    <thead>
        <tr>
            <th>Social History Element</th>
            <th>Description</th>
            <th>Effective Date</th>
        </tr>
    </thead>
    <tbody>
    <tr>
      <td>Feeling dizzy or imbalanced</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Blurry vision or trouble seeing</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Sexual problems</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Trouble eating well</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Teeth, gum or denture problems</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Being extremely tired</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Feeling extremely stressed</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Feeling extremely angry</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Chronic pain</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Out of breath or trouble breathing</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Chest pains or fast heartbeat</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Sleeping problems</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Migraines or severe headaches</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>How would you rate your overall health?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Excellent</td>    </tr>
    <tr>
      <td>Feel embarrassed when meeting new people?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Feel frustrated when talking to members of your family?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Have difficulty hearing when someone speaks in a whisper?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Feel handicapped by a hearing problem?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Experience difficulties when visiting friends, relatives, or neighbors?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Attend religious services less often than you would like?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Have arguments with family members?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Have difficulty when listening to TV or radio?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Limit or hamper your personal or social life?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Experience difficulties when in a restaurant with relatives or friends?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>HHIE-S Hearing Assessment Score</td>      <td>29/8/2015 11:59:26 AM</td>      <td>0</td>    </tr>
    <tr>
      <td>Do you require assistance remembering appointments, family occasions, holidays or taking medications?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Forgetting the name of someone I know well.</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Forgetting important details of things I have done in the past few weeks.</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Forgetting what I was going to say in a conversation.</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Forgetting to do things I said I would do.</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Forgetting what I was going to do when going into another room.</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Forgetting recent events or conversations.</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Retelling a story or joke to the same person because I forgot that I had already told them.</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Finding things I have just put down.</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Completing complex tasks at work or home (i.e. balancing checkbook, planning projects).</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Recalling a specific word I want.</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Little interest or pleasure in doing things</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Not at all</td>    </tr>
    <tr>
      <td>Feeling down, depressed, or hopeless</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Not at all</td>    </tr>
    <tr>
      <td>Trouble falling or staying asleep, or sleeping too much</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Not at all</td>    </tr>
    <tr>
      <td>Feeling tired or having little energy</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Not at all</td>    </tr>
    <tr>
      <td>Poor appetite or overeating</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Not at all</td>    </tr>
    <tr>
      <td>Feeling bad about yourself ? or that you are a failure or have let yourself or your family down</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Not at all</td>    </tr>
    <tr>
      <td>Trouble concentrating on things, such as reading the newspaper or watching television</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Not at all</td>    </tr>
    <tr>
      <td>Moving or speaking so slowly that other people could have noticed.  Or the opposite ? being so fidgety or restless that you have been moving around a lot more than usual</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Not at all</td>    </tr>
    <tr>
      <td>Thoughts that you would be better off dead, or of hurting yourself</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Not at all</td>    </tr>
    <tr>
      <td>If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Not difficult at all</td>    </tr>
    <tr>
      <td>PHQ-9 Depression Assessment Score</td>      <td>29/8/2015 11:59:26 AM</td>      <td>0</td>    </tr>
    <tr>
      <td>How often do you have a drink containing alcohol?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>How many drinks containing alcohol do you have on a typical day when you are drinking?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>1 or 2</td>    </tr>
    <tr>
      <td>How often do you have six or more drinks on one occasion?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>How often during the last year have you found that you were not able to stop drinking once you had started?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>How often during the last year have you failed to do what was normally expected from you because of drinking?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>How often during the last year have you had a feeling of guilt or remorse after drinking?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>How often during the last year have you been unable to remember what happened the night before because you had been drinking?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>Never</td>    </tr>
    <tr>
      <td>Have you or someone else been injured as a result of your drinking?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?</td>      <td>29/8/2015 11:59:26 AM</td>      <td>No</td>    </tr>
    <tr>
      <td>AUDIT - Alcohol Use Disorders Identification Test Score</td>      <td>29/8/2015 11:59:26 AM</td>      <td>0</td>    </tr>
    </tbody>
</table>
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    <thead>
        <tr>
            <th>QuestionText</th>
            <th>AnswerValue</th>
        </tr>
    </thead>
    <tbody>
    <tr>
      <td>Height (inches)</td>      <td>65</td>    </tr>
    <tr>
      <td>Weight (lbs)</td>      <td>228</td>    </tr>
    <tr>
      <td>BMI</td>      <td>37.9</td>    </tr>
    <tr>
      <td>Blood Pressure - Systolic</td>      <td>125</td>    </tr>
    <tr>
      <td>Blood Pressure - Diastolic</td>      <td>79</td>    </tr>
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    <thead>
        <tr>
            <th>Preventive Service Name</th>
            <th>Location</th>
            <th>Date</th>
        </tr>
    </thead>
    <tbody>
    <tr>
      <td>Bone Mass Measurement</td>      <td></td>      <td>1-5 years ago</td>    </tr>
    <tr>
      <td>Cardiovascular Screening Blood Tests</td>      <td></td>      <td>Within last 12 months</td>    </tr>
    <tr>
      <td>Colorectal Cancer Screening</td>      <td></td>      <td>1-5 years ago</td>    </tr>
    <tr>
      <td>Diabetes Screening Tests</td>      <td></td>      <td>Within last 12 months</td>    </tr>
    <tr>
      <td>Glaucoma Screening</td>      <td></td>      <td>Within last 12 months</td>    </tr>
    <tr>
      <td>Hepatitis B Vaccine</td>      <td></td>      <td>Never</td>    </tr>
    <tr>
      <td>Human Immunodeficiency Virus (HIV) Screening</td>      <td></td>      <td>Never</td>    </tr>
    <tr>
      <td>Pneumococcal Vaccine</td>      <td></td>      <td>Within last 12 months</td>    </tr>
    <tr>
      <td>Prostate Cancer Screening for MEN</td>      <td></td>      <td>N/A</td>    </tr>
    <tr>
      <td>Screening Mammography for WOMEN</td>      <td></td>      <td>Within last 12 months</td>    </tr>
    <tr>
      <td>Screening Pap Tests and Pelvic Examination for WOMEN</td>      <td></td>      <td>1-5 years ago</td>    </tr>
    <tr>
      <td>Seasonal Influenza Vaccine</td>      <td></td>      <td>Within last 12 months</td>    </tr>
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</table>
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